AUA is on Capitol Hill, ready to battle reimbursement cuts

Key Points

But having that presence on Capitol Hill is more than a convenience; it's being visible, available on short notice, and being able to respond quickly and effectively when the time is right.

"You've got to go to the dance to get asked to dance," observed Beth Kosiak, AUA associate executive director for health policy.

Most urgent for urologists and other physicians is the pending 10.6% cut in Medicare reimbursement scheduled for July 1 unless Congress once again saves the day. Eventually, however, those last-ditch, temporary efforts will come to an end unless the overall method of determining Medicare reimbursement rates is reformed.

At issue now is legislation being prepared at press time by Senate Finance Committee Chairman Max Baucus (D-MT), which would delay that cut for 18 months and increase payments on average by 1.1%. The bill would cost about $8.4 billion over 5 years; halting the cuts without the increase would cost about $8 billion.

Baucus' bill would use a "balloon financing" mechanism, meaning that physicians would face a payment cut of 21% in 2010. However, Baucus said he would not permit that catastrophe to occur and that in 2009, the broader issue of funding Medicare physician pay will be addressed.

During a meeting with physicians in mid-April, Baucus said he would include other provisions in the bill, such as incentives for using electronic prescribing and other types of electronic health records and expanding the physician quality reporting initiative.

His bill apparently draws from Senate bill S.2785, the Save Medicare Act, sponsored by Sen. Debbie Stabenow (D-MI), which also would stop the pay cuts for 18 months, retain current levels for the remainder of 2008, and would enact a 1.8% increase in 2009. The American Medical Association has been pushing hard for this legislation, arguing that reductions such as the 10.8% cut imposed by the Department of Health and Human Services would sharply reduce access to physician services by Medicare patients.

But the Medicare fee schedule battle is only one fight facing urologists.

As reported elsewhere in this issue (see, "Urologists win injunction against pod lab rule," page 1), a U.S. District Court judge has issued a preliminary injunction blocking an effort by the Centers for Medicare & Medicaid Services to prevent physicians from administering anatomic pathology diagnostic testing services performed in so-called "pod labs." The case was brought by laboratory management services provider Uropath, LLC, and several urology groups.

On March 31, Judge Rosemary M. Collyer, of the U.S. District Court for the District of Columbia, enjoined the enforcement of anti-markup provisions in the Medicare physician fee schedule rule published in November 2007 that applied to such services when provided in a centralized building. CMS said it was concerned that arrangements through which physician group practices or other suppliers provide diagnostic testing services and realize a profit "may lead to patient and program abuse in the form of over utilization of services and result in higher costs to the Medicare program."

In January, after complaints by AUA and other physician groups, CMS delayed the effective date of its regulation for 1 year, except for anatomic pathology diagnostic testing services furnished in a centralized building and for the technical component of purchased tests (The injunction does not apply to purchased technical components). CMS said the delay was needed because the definitions in the original rule "may not be entirely clear, and could have unintended consequences."